变性近视后巩膜加固术后视觉质量改善机制的研究

发布时间：2018-03-05 01:03

  本文选题：变性近视　切入点：后巩膜加固术　出处：《郑州大学》2010年硕士论文　论文类型：学位论文

【摘要】：近视在全球特别在我国发生率很高,在盲和低视力疾病中,变性近视及其并发症所致的盲目占第4-7位。变性近视是眼的前后径(矢状径)进行性延长和巩膜向后扩张而导致后极部视网膜和脉络膜发生病变的眼病,因而严重不可逆地损害视功能。变性近视的预防和治疗逐渐受到众多学者的关注,后巩膜加固术作为去除变性近视的病因,预防变性近视的进展,并防治其并发症的治疗方法,已得到广泛的认可。国内外学者在不断地研究和改进,临床应用取得了一定的成绩,获得了满意的疗效。此手术通过增加眼球壁的厚度,增强巩膜的抵抗力,而阻止近视的发展；并且由加固物的机械和抗原刺激,增加局部的血供和营养,而改善视功能。 后巩膜加固术使变性近视视功能改善的机制,尚无确切的定论。本研究试图通过分析变性近视后巩膜加固手术前后的裸眼和矫正视力、屈光状态、眼A/B超、眼球前后径、光相干断层扫描(OCT)、视野、视觉敏感度及眼电生理检查等各项检查结果,以探讨术后视觉质量改善的机制。 材料和方法 2008年8月至2010年7月间行后巩膜加固术的变性近视45例51眼,右眼31眼,左眼20眼；男21例,女24例；年龄范围为3～72岁。手术前裸眼视力手动／20cm-0.1,平均为0.046±0.038；屈光度-7.00D--27.00D(按等效球镜计算),平均为(-16.71±4.28)D；矫正视力0.01～().8,平均为().296±0.282；眼前后径测量为25.7-36.05mm,平均为(30.03±3.11)mm。加固固材料为同种异体巩膜,手术方法为局部麻醉或全身麻醉下行单条带后巩膜加固术。 统计学分析方法：对术前、术后出院时及2-24月复查3个不同时间点的视力、屈光度、眼前后径、中心视野的光敏度、视觉电生理的波幅和时间等数据,采用计量资料配对t检验方法,眼后极部病变发生率采用卡方检验方法。 结果 1.术后视力：术后裸眼视力：数指/30cm-0.15,平均为0.059±0.047,与术前(0.046±0.038)相比较视力增加,差异有统计学意义(t=2.56,P0.05)；术后2-24月复查时裸眼视力：数指/30cm-0.15,平均为0.064±0.043,与术前相比较视力明显增加,差异有统计学意义(t=2.728,P0.01)；术后矫正视力：0.01-1.0,平均为0.318±0.264,与术前相比较视力增加,差异有统计学意义(t=2.192,P0.05)；术后2-24月复查时矫正视力：0.01-1.0,平均为0.387±0.258,与术前相比较视力增加,差异有统计学意义(t=2.967,P0.01)。 2.术后的屈光度：-7.75～-26.OOD,平均为(-16.25±4.16)D,与术前相比较似有减轻,但差异无统计学意义(t=0.994,P0.05)；术后2-24月复查时的屈光度：-7.75～-26.OOD,平均(-16.39±4.32)D,与术前相比较似有减轻,但差异也无统计学意义(t=0.902,P0.05)。 3.术后2-24月复查测量眼前后径为26.03～35.8mm,平均为(29.96±3.02)mm,与术前25.7-36.05mm,平均为(30.03±3.11)mm对比,差异无统计学意义(t=0.276,P0.05)。 4.本组31眼对比术前术后中心视野的生理盲点扩大、中心相对暗点、旁中心暗点和普遍性损害的形态改变,术后明显改善；对比31眼术前和复查的平均光敏感度缺损值(MD)和总模式偏差值(PSD)。术前MD为-5.14--20.13dB,平均为(-11.61±3.98)dB,PSD为1.93-12.7dB,平均为(5.46±2.86)dB；术后2-24月复查MD为-3.98～-17.94 cB,平均为(-8.32±3.46)dB,PSD为1.56-9.49dB,平均(4.46±2.75)dB,对比差异均有统计学意义(t=2.324和2.103,P0.01)。 5.本组31眼术前行光相干性断层扫描(OCT),发现24眼有并发症,包括脉络膜视网膜萎缩瘢痕11眼,脉络膜新生血管4眼,黄斑前膜2眼,黄斑劈裂者6眼,黄斑孔(全层和板层)7眼,视网膜脱离7眼。术后复查萎缩瘢痕术后2眼有好转；脉络膜新生血管2眼消退；黄斑前膜2眼术后无好转,但对视网膜的牵拉减轻；黄斑劈裂4眼内外层之间桥样劈裂腔完全消失或基本消失；黄斑孔7眼中3眼为板层孔,1眼消失,4眼为全层孔,伴视网膜脱离的黄斑孔,其中3眼脱离消退后黄斑孔消失,1眼黄斑孔未消失；3眼无黄斑孔的黄斑部视网膜脱离,术后均复位,但其中1眼术后2月仍有少量网膜下积液；4眼有孔的黄斑部视网膜脱离,术后视网膜均复位,黄斑孔消失,1眼术后5个月再次脱离,但不伴黄斑孔。对手术前后眼后极部病变行卡方检验x2=6.637,P0.01,差异明显有统计学意义。 结论 1.后巩膜加固术是针对病因的治疗方法,是预防变性近视进展,防治其并发症的有效治疗方法,手术安全可靠。 2.后巩膜加固术后裸眼和矫正视力稳定,部分较术前提高；中心视野缺损形态改善,平均光敏感度缺损值(MD)和总模式偏差值(PSD)均降低。 3.后巩膜加固术后的屈光度和眼前后径稳定。 4.后巩膜加固术改善视觉质量的机制可能是：后巩膜加固术加固了向后延伸的巩膜葡萄肿,缓解了对后极部各层的牵拉,治愈或减轻了变性近视并发的黄斑区瘢痕萎缩、脉络膜新生血管、黄斑劈裂、黄斑前膜、黄斑孔、黄斑部视网膜脱离等,从而提高了视功能,改善了视觉质量。
[Abstract]:Especially in our country in the global myopia incidence rate is very high, in the disease of blindness and low vision, caused by degenerative myopia and its complications accounted for 4-7. The blind eye degenerative myopia is the anteroposterior diameter (sagittal diameter) was prolonged and the sclera expands backward caused retinal and choroidal lesions of the eye therefore, serious irreversible damage of visual function. The prevention and treatment of degenerative myopia has attracted the attention of many scholars, the removal of posterior scleral reinforcement surgery as a cause of degenerative myopia, prevent degenerative myopia progression, treatment and prevention of complications, has been widely recognized. Scholars at home and abroad to study and improve. The clinical application and achieved certain results, obtained satisfactory curative effect. The operation by increasing the eyeball wall thickness, scleral reinforcement resistance, and prevent the development of myopia; and the reinforcement mechanism and antigen thorn Stimulate, increase the local blood supply and nutrition, and improve the visual function.
The mechanism of posterior scleral reinforcement to degenerative myopia visual function improvement, there is no definite conclusion. This study attempts to analyze the degenerative myopia after posterior scleral reinforcement surgery before and after the uncorrected and corrected visual acuity, refraction, ocular A/ B, eyeball, optical coherence tomography (OCT), vision, visual sensitivity and EOG the physiological examination of the test results, to explore the mechanism of the improvement of visual quality after surgery.
Materials and methods
Of the 45 cases of degenerative myopia reinforcement surgery between July 2010 and August 2008 51 scleral line, right eye in 31 eyes, 20 eyes left; 21 cases were male, 24 were female; the age range was 3~72. Preoperative visual acuity manual / 20cm-0.1, with an average of 0.046 + 0.038; -7.00D--27.00D diopter (according to spherical equivalent calculation) on average, (-16.71 + 4.28) D; 0.01 (.8) - corrected visual acuity (.296), an average of + 0.282; anterior and posterior diameter measurement is 25.7-36.05mm, the average (30.03 + 3.11) for allogeneic scleral reinforcement surgery method for mm. solid material, or under local anesthesia for single band scleral reinforcement body anesthesia.
Statistical analysis methods: preoperative, postoperative discharge and 2-24 months after the 3 different time points of the visual acuity, diopter, anteroposterior diameter, light sensitivity of central visual field, visual electrophysiology amplitude and time data, measurement data using the paired t test method, posterior polar lesions were calculated by the method the chi square test.
Result
1. vision: postoperative uncorrected visual acuity: refers to the number of /30cm-0.15, an average of 0.059 + 0.047, and the preoperative (0.046 + 0.038) compared to visual acuity increased, the difference was statistically significant (t=2.56, P0.05); 2-24 months after operation were uncorrected visual acuity: the number of /30cm-0.15, an average of 0.064 + 0.043. Compared with the preoperative visual acuity was significantly increased, the difference was statistically significant (t=2.728, P0.01); the postoperative corrected visual acuity: 0.01-1.0, the average was 0.318 + 0.264, compared with the preoperative visual acuity increased, the difference was statistically significant (t=2.192, P0.05); after 2-24 months of corrected visual acuity: 0.01-1.0, an average of 0.387 + 0.258, compared with the preoperative visual acuity increased, the difference was statistically significant (t=2.967, P0.01).
2. postoperative refraction: -7.75 ~ -26.OOD, average D (-16.25 + 4.16), compared with preoperative seems to be reduced, but the difference was not statistically significant (t=0.994, P0.05); after 2-24 months of diopter: -7.75 ~ -26.OOD, the average (-16.39 + 4.32) D, compared with compared with the preoperative seems to be reduced, but there was no statistically significant difference (t=0.902, P0.05).
3., 2-24 months after operation, the anterior posterior diameter was 26.03 to 35.8mm, with an average of (29.96 + 3.02) mm, and there was no statistically significant difference compared with preoperative 25.7-36.05mm (30.03 + 3.11) mm (t=0.276, P0.05).
Expand the physiological blind spot in 31 eyes 4. compared preoperative and postoperative vision center, central relative scotomata, change the paracentral scotoma and general damage morphology were improved obviously after operation; the average light sensitivity defect contrast 31 eyes preoperatively and review the value (MD) and total deviation (PSD) mode of operation. MD -5.14--20.13dB, an average of (-11.61 + 3.98) dB, PSD 1.93-12.7dB, the average (5.46 + 2.86) dB; after 2-24 months of MD -3.98 to -17.94 cB, average (-8.32 + 3.46) dB, PSD 1.56-9.49dB, the average (4.46 + 2.75) dB, differences were statistically statistically significant (t=2.324 and 2.103, P0.01).
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